Ch 89 Rheumatoid Arthritis Flashcards

1
Q

What is rheumatoid arthritis

A

A CHRONIC, progressive inflammatory disease that can affect tissues and organs but, principally affects the joints producing an inflammatory synovitis. It involves joints bilaterally and symmetrically, & it typically involves several joints at one time. RA typically affects upper joints first.

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2
Q

What is RA precipitated by

A

It is an auto immune disease precipitated by WBCs attacking synovial tissue. The WBCs cause the synovial tissue to become inflamed and thickened. The inflammation can extend to the cartilage, bone, tendons, and ligaments that surround the joint. Joint deformity and bone erosion may result, decreasing the joints ROM and function.

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3
Q

What does the phrase RA is also a systemic disease mean

A

It can affect any connective tissue in the body. Common structures that are affected are the blood vessels, pleura surrounding the lungs, and pericardium. Iritis and scleritis can also develop on the eyes…
The natural course of the disease a exacerbations and remissions

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4
Q

What are risk factors of rheumatoid arthritis

A
Female gender 
Age 20-50 years 
Genetic predisposition 
Epstein Barr virus 
Stress 
Enviromental factors
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5
Q

What are early signs of rheumatoid arthritis

A

Fatigue

Joint discomfort

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6
Q

What is subjective signs of RA

A

Pain at rest and with movement
Am stiffness
Pleuritic pain ( pain upon inspiration)
Xerostomia ( dry mouth) Subcutaneous nodules
Anorexia/ weight loss Low grade fever
Fatigue Muscle weakness/ atrophy
Paraesthesias Reddened sclera and abnormal pupil shape
Recent illness/ stress Lymph node enlargement
Joint pain/ lack of function

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7
Q

What is objective assessment data of RA

A

Joint swelling, warmth and erythema

Ulnar deviation, swan neck, and boutonnière deformities are common in the fingers

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8
Q

What joints are generally affected by RA

A

Finger, hands, wrists, knees, foot joints

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9
Q

What are lab tests to diagnose RA

A
  1. Anti- CCP will be positive ( this test detects antibodies to cyclic citrullinated peptide…. The test will test + long before symptoms appear…. Very sensitive test to RA
  2. RF antibody. High tigers correlate with severe disease
  3. ESR
  4. C reactive protein
  5. ANA titer
  6. Elevated WBC
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10
Q

What is the erythrocyte sedimentation rate

A

Elevation is associated with inflammation or infection in the body

20-40 indicates mild inflammation
40-70 indicates moderate inflammation
70-150 indicates severe inflammation
* other autoimmune diseases can increase ESR

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11
Q

What is ANA

A

Anti nuclear antibody

antibody produced against ones own DNA

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12
Q

What are diagnostic procedures for RA

A

Arthrocentesis ( synovial fluid aspiration by needle, with RA, increased WBC and RF are present in fluid

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13
Q

What is recommended teaching for morning stiffness related to RA

A

Hot shower

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14
Q

What is recommended teaching for edema

A

Cold therapy

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15
Q

What are medications for RA

A

Treatment begins with NSAIDS which provides analgesic, antipyretic, and anti inflammatory effects…NSAIDS can cause considerable GI distress.

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16
Q

If NSAIDS cause considerable GI distress, what can be done

A

Request a concurrent prescription for a GI lowering agent ( antihistamine 2 receptor antagonist,PPI) …… Monitor for fluid retention,HTN, and renal dysfunction

17
Q

What are other meds for RA

A

COX-2 enzyme blockers
Corticosteroids
Disease modifying anti rheumatic drugs ( DMARDS)
Anti malarial agent ( hydroxychloroquine { Plaquenil})
Antibiotic ( minocylcine { Minocin}
Sulfonamide ( sulfasalazine { Azulfidine}
Biologic response modifiers
Cytotoxic medications… Methotrexate, leflunomide, cyclophosphamide,and azathioprine.

18
Q

How do DMARDS work

A

They work In a variety of ways to slow the progression of RA and suppress the systems reaction to RA that causes pain and inflammation…..relief of symptoms may not occur for several weeks